“Ten percent” rule for meaningful use on CPOE is weak!

Idon’t usually feel compelled to comment on healthcare policy, but something I read recently has me a little miffed. The Meaningful Use Work Group of the ONC’s HIT Policy Committee recommended that 10 percent of orders be entered via CPOE to meet criteria for funding in 2011. Since when is ten percent considered successful. I’ve been through many years of schooling; I’m a veteran pharmacist of more than ten years “in the trenches” and have now been involved with many technology projects in my relatively new role as an IT pharmacist. Never has ten percent of anything been considered acceptable. Try telling your boss you’re only going to give ten percent. Note the reaction on his/her face.

– Our facility implemented Alaris Smart Pumps to improve patient safety. Did we implement the pumps on only ten percent of the nursing floors? No, we put the pumps on every floor.

– Our facility implemented automated dispensing cabinets (ADCs) throughout the hospital to decrease diversion and increase patient safety. Did we do it for ten percent of the nursing stations? No, we have ADCs on every nursing unit.

– Our facility implemented barcoding technology in the pharmacy to improve patient safety. Did we settle for barcoding ten percent of medications? No, our goal was 100% and we did it.

– Our facility implemented PARx scanning to improve replenishment accuracy in our ADCs. Did we stop at ten percent? No, we now utilize PARx on all our ADCs.

I can’t imagine creating a proposal for any project that offers ten percent completion as the goal. Can you? No, I didn’t think so. The goal of CPOE implementation should be approached the same as any other patient safety initiative. Considering that CPOE implementation qualifies facilities for government funding, we should be shooting for 100% implementation with no option for less. Don’t forget that the ARRA is offering millions of dollars of tax payer money to fund “meaningful use”. If I’m flipping the bill, I want my money’s worth.

Our facility processes between 1500 and 2000 orders per day. Many of these orders require clarification secondary to poor handwriting, missing elements (i.e. dose, route, frequency, indication, etc), or because they are simply incorrect. When properly implemented, CPOE promises to eliminate many of these issues. As a practicing pharmacist I want to see CPOE implemented. I want a system in place that forces physicians to write complete orders. I want a system that forces physicians to justify medication usage outside acceptable “norms”. Ten percent just isn’t going to do it.

An article written by Mark Hagland over at Healthcare Informatics titled Could Ten Percent Be About Right…? argues that “in a situation that is going to require that we all accept imperfection to begin with (after all, this whole process is going to be like asking a thousand archers to try to hit a bull’s-eye on a moving target, I think!), 10 percent sounds more or less about right to me.” I’m not sure how Mr. Hagland drew his conclusions, but his profile says he has been a professional journalist for 26 years. Hmm, I wonder how many thousand hand written medication orders Mr. Hagland has had to deal with in his journalistic career. CPOE is a system designed to be used by healthcare professionals to increase patient safety. I invite Mr. Hangland to sit next to me for a 10 hour shift some day and help me interpret all the hand written medication orders I receive. In an average shift I will process approximately 400 orders. Ten percent (or more) of those orders are pure garbage and require multiple phone calls to irritated nurses and “not so friendly” physicians for clarification.  I look forward to not having to make those phone calls, Mr. Hagland. The only way to accomplish this is to make CPOE required for 100% of medication orders in an acute healthcare facility.

Ten percent has never been an acceptable goal for any project. With all the money involved, and with patient safety at risk, it’s time to step up and make some tough decisions. Do it right the first time or don’t do it at all.

3 thoughts on ““Ten percent” rule for meaningful use on CPOE is weak!”

  1. Sorry to sound so cynical, but this reeks of lazy/god complex doctors pushing back. Hopefully your hospital will push for 100%. Maybe a 10% start, to test the system, with a goal to go 100% in a short period of time, say three months. That seems perfectly reasonable.

  2. Hi Rick – Ha! While that may be true, what about a professional basketball player that only shoots 10% or a professional field goal kicker that only hits 10% of their field goals? When I was in the military, hitting 10% of your targets meant you were a complete failure. I understand that it’s not going to be easy, but there’s several million dollars of government funding at stake. It takes 12-18 months to successfully implement a CPOE system. Hospitals have time. Thanks for the comment.

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